Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: feasibility, safety and predictors of when not to attempt it.

The purpose of this study was to evaluate the feasibility and safety of immediate extubation (ultrafast-track anesthesia [UFTA]) in the operating room, and the predictors of when not to attempt it in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Case series. A private hospital. One thousand one hundred ninety-six patients undergoing OPCAB surgery, representing 4 years of a single anesthesia service's practice (3 anesthesiologists), were evaluated for immediate extubation. All patients were considered amenable to immediate extubation if specific criteria were met. Patients received general anesthesia (UFTA protocol) and underwent off-pump coronary artery bypass graft surgery. One thousand sixty-five patients (89%) met extubation criteria and were extubated successfully in the operating room. By multivariate analysis, the following independent predictors of avoiding immediate extubation were identified: reoperation (odds ratio [OR] = 3.9, p < 0.001), pre-existing renal disease (OR = 3.1, p < 0.0001), diabetes (OR = 1.7, p < 0.007), preoperative intra-aortic balloon pump placement (OR = 7.4, p < 0.0001), and total surgical time (OR = 3.7, p < 0.0001). Patients who met extubation criteria had lower in-hospital reintubation (2.5% v 16%, p < 0.001), myocardial infarction (1.03% v 4.58%, p = 0.001), renal insufficiency (2.2% v 7.63%, p < 0.001), stroke (0.4% v 2.29%, p = 0.032), and mortality rates (1.2% v 10.7%, p < 0.001) than patients who did not. UFTA is feasible and safe in most patients undergoing OPCAB surgery. Baseline and intraoperative data predicted when immediate extubation should not be attempted.

Dorsa AG ，Rossi AI ，Thierer J ，Lupiañez B ，Vrancic JM ，Vaccarino GN ，Piccinini F ，Raich H ，Bonazzi SV ，Benzadon M ，Navia DO ... -  《-》

[Operating room extubation (ultra fast-track anesthesia) in patients undergoing on-pump and off-pump cardiac surgery].

Borracci RA ，Dayán R ，Rubio M ，Axelrud G ，Ochoa G ，Rodríguez LD ... -  《-》

Resource utilization in on- and off-pump coronary artery surgery: factors influencing postoperative length of stay--an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia.

Scott BH ，Seifert FC ，Grimson R ，Glass PS ... -  《JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA》

Ultra-fast-track anesthetic technique facilitates operating room extubation in patients undergoing off-pump coronary revascularization surgery.

To determine if implementation of ultra-fast-track anesthetic (UFTA) technique facilitates operating room extubation in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. Retrospective review. Referral center for cardiovascular surgery at a university hospital. Thirty-seven patients undergoing off-pump CABG surgery. Two groups represented UFTA (n = 10) and standard anesthetic (controls, n = 27) techniques. Anesthesia was conducted with propofol, remifentanil, vecuronium, and thoracic epidural analgesia in the UFTA group and thiopental, fentanyl, pancuronium, and isoflurane in the control group. Active temperature control was an integral part of the UFTA technique but not the standard technique. The active temperature control included intravenous fluid warmer, prewarmed skin preparation, humidified inspired gases, a circulating water warming blanket, and a forced-air warmer, along with the maintenance of the operating room temperature at 24 degrees C. The control group was managed with an intravenous fluid warmer, and the ambient temperature remained constant (20 degrees C). Patients who did not satisfy extubation criteria within 30 minutes from the end of surgery were sedated and transferred to the intensive care unit (ICU). All patients in the UFTA group and 2 in the control group were extubated in the operating room immediately after surgery. None of the patients required reintubation. There was no significant difference in postextubation PaO(2) and PaCO(2) between the groups. Nasopharyngeal temperature decreased from 36.7 +/- 0.4 degrees C to 36.4 +/- 0.3 degrees C in the UFTA group and from 36.6 +/- 0.5 degrees C to 35.6 +/- 0.4 degrees C in the control group (p < 0.0001). Bradycardia occurred significantly more often in the UFTA group but there was no difference in episodes of hypotension. There were no perioperative deaths. Patients who were extubated in the operating room required lower nurse-to-patient acuity ratio (1:2) in the ICU. No difference was found in ICU and hospital length of stay. Implementation of UFTA technique provided adequate hemodynamic control and facilitated operating room extubation in all patients. The impact of UFTA on earlier patient discharge and actual cost savings within a fully integrated post-cardiac surgery unit requires further evaluation.

Djaiani GN ，Ali M ，Heinrich L ，Bruce J ，Carroll J ，Karski J ，Cusimano RJ ，Cheng DC ... -  《-》

Routine immediate extubation after off-pump coronary artery bypass surgery: 514 consecutive patients.

Horswell JL ，Herbert MA ，Prince SL ，Mack MJ ... -  《-》